When you're tossing fruit, ice and other smoothie mix-ins into your blender, take an extra second to add one more metabolism-boosting ingredient -- whey protein powder. "Whey protein increases calorie burn and fat utilization, helps the body maintain muscle, and triggers the brain to feel full," says Paul Arciero, a professor in the Health and Exercise Sciences department at Skidmore College who has studied whey's effects on the body. All types of protein rev up your metabolism -- protein has a thermogenic effect, meaning it makes your body produce more heat and, in turn, burn more calories -- but whey may be the most effective non-meat protein. A study published in the American Journal of Clinical Nutrition revealed that fat oxidation and the thermic effect was greater with whey than with soy or casein.
Flash back to the summer of 2014 when the baller slimmed down his 6-foot-8-inch-tall frame. When James showed off a six-pack in a series of Instagram posts, everyone got buzzing about what changes he’d been making. Dozens of news stories revealed the keto diet was the major reason. He told Sports Illustrated in September 2014 that he didn’t eat dairy, sugar, or carbohydrates for 67 days. The reasoning? To “test his mental fortitude.” Some outlets, including Business Insider, speculated he was trying to follow Kobe Bryant, who lost weight in his mid-thirties and ended up giving his career a second wind.
If you're like many women over 40, you've probably noticed that it's become a lot easier to gain a few pounds than to lose them. The foods that you ate without care in your 20s and 30s now stick to your body like glue, adding bulk to your midsection. The good news: The solution to a slim, firm body at 40-plus is no farther than your fridge. Research shows that, when combined with a little regular exercise, what you eat and when you eat it are your metabolic secret weapons for building muscle mass, the body's prime calorie-burning tissue and a key driver of your metabolism. What Men Over 40 Need To Eat In Order To Get Six Pack Abs
Whether it’s playing with your dog, carrying the stroller for your family members with little ones, or exploring a nature path, it’s crucial to fit in extra activity when you can. “Metabolism and hormonal changes in your 40s create an ideal environment for excess fat storage in women – especially in the midsection,” says Marisa Moore, MBA, RDN, LD. “In your 40s, activity is essential.”
Dried goji berries might be a staple of every health food store, but it’s worth looking for them a couple aisles over in the tea section. Lycium barbarum, the plant from which goji berries are harvested, is a traditional Asian therapy for diabetes and other diseases, but it also boasts a slimming effect. In a study published in the Journal of the American College of Nutrition, participants were either given a single dose of L. barbarum or a placebo after a meal. The researchers found that one hour after the dose, the goji group was burning calories at a rate 10 percent higher than the placebo group, and the effects lasted up to four hours. Bonus: Most goji teas are mixed with green tea, further boosting your calorie burn.
Not that we should really argue with anyone whose nickname is "The Body," but the supermodel's method to looking so phenomenal at 51 is kind of a headscratcher for those not familiar. Relying on the ideology that an acidic body is more susceptible to disease that can throw metabolism and other things out of whack, Macpherson eats alkaline foods (including whole grains, leafy greens) and avoids things like coffee and alcohol in order to keep her inner pH balance in check. She even cops to taking pee tests in order to make sure things are in order. And she's not the only A-lister who does so: Victoria Beckham, Gwyneth Paltrow, and Jennifer Aniston are also fans—and considering that's pretty much the Good Body Brigade, we'd say they're onto something.
boosting your metabolism after 40
Studies show that how you eat and live contribute significantly to how you transition through menopause. And while Brenda vigilantly monitored her caloric intake, she was eating too much dairy and other inflammatory foods that created hormonal imbalances in addition to living an action-packed lifestyle with few outlets for stress reduction. Meanwhile, her regular, intense cardio workouts spiked Brenda’s fat-storing hormone insulin and stressed out her (already overworked) adrenal glands.
It’s no surprise that as we age, our metabolism slows down, says Leah Kaufman, MS, RD, CDN, founder of Just for Today. Exercising in a different way or at a higher intensity may help get your metabolism back to where it once was. “Changing up your routine can increase the speed at which your body is burning calories,” she says. Try one of these Best Workouts for Weight Loss!
I discovered this author when she was a guest "on the porch" of Ann Vokamp. I was intrigued when I read she and her family were salmon fishermen in Kodiak, Alaska because my family had spent 3 years in Kodiak. Well I am so glad I found her! I loved this book. It was motivating and encouraging to read from so many women going through different stages in life. Leslie's writing is real and vulnerable and stirs my heart for more of Jesus and Jesus living. I love her blog and can't wait to read another of her books. If you are a women of any age, you will glean so much from this book of wisdom. My Diet and Exercise Routine! After 40!
Want to maximize your fat-burning potential after 40? Start by making sure you’re getting plenty of calcium in your diet. The results of a study conducted at the University of Tennessee, Knoxville reveal that obese women who consumed more calcium lost 11 pounds of body fat in over a 12-month period. Even better, increasing your calcium intake can help increase the strength of your bones, reducing your risk of a fall or fracture.
food to increase metabolism after 40
For lunch, I craved something savory, so I opened the “chicken rice dinner” jar. The dog food smell assaulted me. I gagged so loudly that my roommate thought I was having a meltdown, which was true. I looked at the first ingredients of the so-called chicken and rice feast: carrots and water. The third ingredient was ground chicken. There was no seasoning. It was horrific. That night for dinner, now able to eat real human food as I’d checked off my two baby food meals, I ordered enough Chinese food for a family of seven and ate every last shred of it.
Organic, local, gluten-free and vegan, the Sakara food plan delivers meals straight to your home or office. It's up to you to decide if you want a one-day cleanse, a five- or 20-day plan, or a three-month subscription. Whitney Tingle and Danielle DuBoise founded the company in 2011 to "promote balance in all areas of life...true health means you're making the right choices for your body because you want to, not because you have to." Customer Iman says of the program, "Danielle and Whitney make quite a pair and all they want is for women to feel good in their bodies. They are sharing their passion for great food, and great style, with the rest of the world."
Want to lose weight and have healthy meals you can prepare quickly? That's the premise behind celeb trainer Harley Pasternak's 5-Factor Diet, which calls for three meals and two snacks daily. The recipes don't take long to make and each one includes protein, fibre, carbs, fluids and a bit of healthy fat--designed so you don't feel hungry or deprived.
I’ll be sharing a list of 15 things that no woman who is middle-aged and older should have. But this isn’t going to be one of those judgmental lists that makes you feel bad about getting older. This list is meant to be empowering, and help you get rid of the unnecessary clutter that tends to build up over the years! As older women, we have moved into a more mature and practical stage of life, and our homes should reflect that! So get those garbage bags ready, because it’s time to clear out some clutter. :-)
"The main culprit that slows metabolism and often leads to yo-yo dieting is what I call shrinking muscle syndrome," says Caroline Apovian, MD, director of the Nutrition and Weight Management Center at Boston Medical Center and the author of The Overnight Diet: The Proven Plan for Fast and Permanent Weight Loss. Starting at age 30, most people begin to lose about half a pound of the metabolism-revving tissue each year. Poof! Gone, just like that. And at age 50, the rate doubles. "The average sedentary woman may have lost nearly 15 pounds of muscle by the time she reaches her late 50s, a change that could cause her to gain nearly the same amount in body fat," says Wayne Westcott, PhD, a Prevention advisory board member and the director of fitness research at Quincy College in Massachusetts.
To begin, you need to figure out your metabolic rate based on your age, height, weight and activity level. This data will help determine how may calories your body can consume before you actually start putting on weight. Then you’ll learn how to adjust that number so you can boost your metabolism and start losing pounds. Click here for a Metabolism Calculator.
I am a 58 year old female and weigh exactly the same as I did at 16. I have always had a huge appetite and I still eat as much as the children and the men in the family. I have always exercised (I am a marathon runner) but have not found any of the scare stories to be true – I have not accumulated belly fat and my metabolism has not slowed down. I think these articles can be misleading and cause unnecessary worry about the ageing process.
Let's face it: Finding time to exercise only gets harder as you age. It helps to remember that working out gives you the sanity, strength, and good health to keep the rest of your world running smoothly. Can an overweight woman really preach to her children about the merits of eating right? Can an out-of-shape mom hope to get through an afternoon of soccer with her son without gasping for breath? Committing to a fitness routine is the first step in becoming a positive force to those around you. The time crunch isn't going to go away, so maybe you'll need to wake up earlier, or use your lunch break to hit the gym or walk home from work instead of driving. The better shape you're in, the better you'll feel inside and out. And the better you feel, the easier it will be to deal with life's headaches -- like demanding bosses, moody teenagers, and your husband's addiction to Monday Night Footbal. Some things you can't change. Thank goodness your weight isn't one of them.
A new report from the Credit Suisse Research Institute found that more and more of us are choosing whole-fat foods over skim, lite, fat-free or other modern monikers of leanness. And while many health organizations like the American Heart Association still want us to cut down on fat—particularly saturated fat—this full-fat trend may be a healthy rebellion against those decades-old credos, according to recent studies. In fact, people who eat a lot of high-fat dairy products actually have the lowest incidence of diabetes, according to a 2015 study of 26,930 people in the American Journal of Clinical Nutrition. Those who ate a lot of low-fat dairy products, on the other hand, had the highest incidence. The researchers speculated that while calcium, protein, vitamin D, and other nutrients in yogurt are indeed good for us, we need the fat that goes along with them in order to reap their protective effects. These are some of the 20 Best Full-Fat Foods for Weight Loss!
I was the type of person who up until my late 30s could eat whatever I wanted and never work out and rarely gained a pound. If I wanted to “loose” weight meaning the five pounds of holiday weight I had put on all I had to do was start exercising doing some cardio and it fell off. Then all the sudden that stopped and now I am 20 pounds over weight and almost 41 years old and the only way for me to loose weight is to starve. I have been tested for medical conditions, I do not take any medications. I have been to a nutritionist, several actually. I have revamped my diet, I have done weight watchers, I hired a trainer and I work out 6 days a week. I have been told work out less you will be less hungry, did that nada. Cut carbs, cut diary, tried that too. The conclusion I have come to is that due to my small frame (I am only 5’1) I have to work out daily and not eat more than 1200 calories a day if I want to lose weight. I cannot do that, it makes me utterly miserable and angry. I had my metabolism tested via one of those breathing machines and it was so slow. Doctors will never admit that anyone should eat less than 1200 but my doctor looked at me and basically said 1200 is the maximum you can eat. I have never yo yo dieted, in fact I was never on a diet until I was 38, never needed to be. My Mom had the same exact thing happen to her. At this point I have two choices, be miserable and hungry all of the time, or be 20 pounds over weight and be happy, I chose the latter. Trying to live and eat 1200 calories a day every single day, is not reasonable and is a recipe for failure. I compare this to men who don’t want to admit that as they age they need Viagra. All of them say oh no I have sex like a 20 year old, no you don’t. And they don’t talk about their struggles with each other they just boast. For women I think we may just need to accept that extra 20 pounds that comes along with age, rather than fighting a loosing battle and being miserable.
how to build muscle in your 40s
Your 40s are not the time to try fad diets for quick weight loss. You're smarter than that. You need a plan for long-term health, well-being, weight loss and weight maintenance. To do that, set SMART goals. SMART goals are used by motivational coaches to help anyone become more successful. If you want your weight loss plan to work, you'll set one too. It takes just 30 minutes or less to set up and it provides a roadmap for your entire weight loss journey.
Think about it: Say you're twice as active as an influencer you follow. Eat exactly what she eats, and you'll feel way more tired and way more hungry than she is, since your body likely requires more fuel to operate, Dr. Seltzer says. A more appropriate diet that's based on your specific energy needs may involve way more food—like two ice-cream scoops instead of one!—and give you way more energy so you can live your best life, hanger-free.
They may be packed with protein and keto-friendly, but processed meats can wreak havoc on your health. Deli meats, bacon, and hotdogs usually contain cancer-causing nitrates and nitrites as well as pack in elevated amounts of blood-pressure-spiking sodium. A 2013 study published in the journal European Cytokine Network found that sodium nitrate increases oxidative stress, which can damage youthful-skin-promoting collagen and elastin.
Instead of ditching carbs or going low-fat, try a diet that's rich in veggies, beans, and legumes to increase your metabolism — and keep your blood sugar from spiking. "Many people think weight is all about calories in, calories out, but quality also matters," says Aunna Pourang, M.D. "[In a 2012 study], low-carb diets showed the most increase in metabolism, but also showed an increase in the stress hormone cortisol. This is why scientists concluded that the low-glycemic diet worked the best."
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One of the most admired and revered women in India as well as in the world. Through her successful career, she has established herself as one of the most popular and influential women in India. Rai has received numerous awards and accolades, and she was also awarded the Padma Shri by the Government of India in 2009. No doubt, she’s the “most beautiful woman in the world”.
If you've ever wondered how your favourite celebrities maintain their svelte figure, you're not alone. We admire their perfect bikini bodies from afar, assuming it's all because of their personal trainers and live-in chefs--and while that may be true, it's also because of their strict diets. Just in time for beach season, we're sharing the ten diets celebrities swear get them in tip-top shape.
Eat more protein. Sarcopenia, or loss of muscle due to age, has been seen as inevitable, but a great deal of its severity is dictated by diet and exercise. Protein can help! One study found that men and women between ages 70 and 79 who ate the most protein lost 40 percent less lean mass than those who ate the least protein. Muscle burns more calories, increases your insulin sensitivity, and keeps your testosterone production higher so that you can help stave off age-related health conditions, such as metabolic syndrome, diabetes, and loss of libido.
Most women in the ripe years have already found their own styles and could have enjoyed their lives just keeping them in line with current trends. Unfortunately, age-related changes foul things up, affecting face features, body and hair. However, there are lots of stylish hairstyles for women over 40, flattering both the face and body silhouette, while factoring out years. You just need to focus on the personal traits we are going to discuss further. Ultimate Workout for Belly Fat Loss - Cardio and Abs Workout
While maintaining and building lean muscle mass is the best way to keep your metabolism humming, research shows that staying hydrated may also increase calorie burn, especially if your beverage is cold and frosty. How? Your body has to heat up icy drinks to reach body temperature, which requires energy. Making your drink of choice green or oolong tea can also give your metabolism an added boost, according to Japanese researchers.
Your body needs water to process calories. If you are even mildly dehydrated, your metabolism may slow down. In one study, adults who drank eight or more glasses of water a day burned more calories than those who drank four. To stay hydrated, drink a glass of water or other unsweetened beverage before every meal and snack. Also, snack on fresh fruits and vegetables, which naturally contain water, rather than pretzels or chips. My 3 Ways For Men Over 40 To Help Lose Weight
“Menopause is right around the corner, which means muscle mass and bone density both start to decline,” Honaman says. Most women in their 40s are aware of this. “For me, that was a far stronger motivation to get to the gym and to adopt a more healthy lifestyle than the motivation of showing up at the pool in a bikini had been decades earlier. It’s about more than just vanity; the health stakes are higher now that ever before.”
A 2014 study found that the type of fat we consume might make all the difference. Participants in the study were asked to eat 750 extra calories every day for seven weeks. Those having excess calories from saturated fats had activated cells that promoted fat storage in the belly and increased insulin resistance. However, individuals who had a high consumption of polyunsaturated fats found in fatty fish, nuts and seeds, gained less abdominal fat and were more likely to increase muscle mass instead.
For the longest time in the 80s and 90s, Pamela Anderson was the definition of sexy. Wearing her red one piece while running in slow motion, the Baywatch babe stole our hears and never gave them back. She regularly appeared in Playboy and now is a spokeswoman for PETA. She recently graced our screens again returning as C.J for a cameo in the 2017 adaption of Baywatch.
Derived from the Japanese tencha leaf and then stone-ground into a bright-green fine powder, matcha literally means “powdered tea,” and it’s incredibly good for you. Research shows the concentration of epigallocatechin gallate (EGCG) in matcha to be 137 times greater than the amount you’ll find in most store-bought green tea. EGCG is a dieter’s best friend: Studies have shown the compound can simultaneously boost the breakdown of fat and block the formation of belly-fat cells. One study found men who drank green tea containing 136 milligrams of EGCG—what you’ll find in a single four-gram serving of matcha—lost twice as much weight than a placebo group and four times as much visceral (belly) fat over the course of three months. Need one more reason for tea time? A single serving sneaks in four grams of protein—that’s more than an egg white!
Guadagnino came back into the spotlight in 2018 with the reboot of MTV’s hit reality TV show Jersey Shore, called Jersey Shore Family Reunion. In the six years since the MTV show last aired, PopSugar reported in May 2018 that Guadagnino has adopted the keto diet and launched a dedicated Instagram account where he goes by @ketoguido. He recommends eating eggs, bacon, butter, steak, fatty fish, plants, and exercising a few times each week. According to a March 8, 2018, Instagram post, Guadagnino says his old way of eating had him 50 lbs heavier and looking 10 years older.
This tea is known for its powerful thermogenic effects—meaning it turns up your body’s calorie-burning mechanism—and can also promote weight loss by improving insulin sensitivity. In a recent study, participants were divided into two groups where one group took a placebo 60 minutes prior to exercise and the other group ingested a 1,000-milligram capsule of yerba maté. Researchers found that those who consumed the herb increased the beneficial effects their workout had on their metabolism. Yerba maté is just one of the 22 Best Teas for Weight Loss!
However, just like those rehab-loving design gurus on HGTV, your body breaks down muscle as regularly as it builds it. "All of the cells in your body need protein to function. When there aren't enough amino acids from food available in the bloodstream, the body will start to break down and harvest amino acids from your muscle in order to keep more vital cells—like the ones in your brain and other organs—functioning," says Dr. Paddon-Jones. "This is a natural, continuing cycle. Muscle-protein synthesis goes up after you eat a meal with protein, and your body switches back to muscle-breakdown mode a few hours after you've eaten. Normally, the ups and downs equal out and your muscle mass stays the same." However, eat too little protein for too long and your muscles start to shrink, eventually causing your metabolism to take a nosedive.
Conclusion: I wouldn’t recommend exclusively eating smoked salmon and capers any longer than one day, as scurvy is a very real and serious affliction (you know, among other things). But if you love smoked salmon and capers and want to get your lifetime supply of Omega-3s in one fell swoop, this diet plan is for you. Just make sure you don’t have any plans to socialize during the day because it’s sort of awkward to bring a pack of smoked salmon along on, say, a date. Awkward, yes … but not unheard of. Another story for another time.
Holiday weight – usually all but melted by Valentine’s Day – seems reluctant to budge when you throw your old tricks at it. If it seems that something important has shifted, you’re right. Your metabolism is slowing, and your muscle mass is decreasing. That’s a harsh reality, but there are some new tricks for you to learn to keep spry for years, even decades to come. We’ve listed 40 of them for you here so that you needn’t go gentle into that good night. Building Muscle After 40?!
Getting a good start to your day means working on your weight loss before you even sit down to breakfast. A study published in Obesity reveals that the combination of fasting and exercise produced greater weight loss in study subjects than either calorie restriction or exercise alone. Luckily, a better body is well within reach—just make sure these 7 Most Surprising Everyday Exercise Killers aren’t standing in your way first.
Another gluten-free grain, quinoa is loaded with protein as well as all nine essential amino acids that we need for energy and growth. What’s more, “Whole grains give us fiber, which is key to helping digestion and satiety,” Carrillo explains. “They allow you to stay satisfied for longer. Whole grains prevent the rise in blood sugar as well and help to regulate blood sugar. They also work to reduce cholesterol, which is heart healthy.”
To achieve a better macronutrient ratio, don’t worry about counting macros with fancy apps. All you need to do is break down your meals like this: center your meals around non-starchy vegetables such as broccoli, cauliflower, lettuce, kale, peppers, zucchini, mushrooms and green beans. Fill at least half of your plate with these lower calorie, high-fiber foods to satisfy hunger and pack in the nutrition. How to start a healthly lifesyle and lose weight after 40 I Get fit and healthy
The more years we live, the higher our risk of developing a disease, especially heart disease, cancer, stroke and diabetes. All of these conditions are tied, in some way, to inflammation. A 2017 study from Georgetown showed that mindfulness meditation had a significant impact on reducing stress hormones and inflammatory proteins and a 2014 study found that just 25 minutes of meditation a day could alleviate stress levels.
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Absolutely agree. I’m coming up to 64 years old and have managed to loose weight, gain lean muscle and strength by a combination of healthy eating and regular vigorous exercise. I prefer to do my gym sessions in a functional gym where I can combine HIIT training with some basic weight training and strength exercises such as prowler pushing, battle rope exercises or tyre flips. Over the past 6 months I’ve seen an amazing change in my body shape and I’m now maintaining a healthy weight and body mass index as I shed fat and gain lean muscle. The key to success is to enjoy a varied training schedule and not get stuck into repeating the same exercises every session.
Okay, now that you're cooking lighter fare, don't blow it by adding unnecessary calories. The recipe may call for a generous brushing, pouring or slathering of oil or butter, but you know better. Butter has a whopping 90 calories per tablespoon; every type of oil has 120. The over-40 edit of all your recipes should read: "drizzle," "lightly spray," or "dab" the butter. Think of it this way: Kids' dinners are high in fat because oil is used to add flavor to an otherwise bland meal. But if you start with a quality cut of steak or fillet of fresh fish, why destroy the flavor by suffocating it in grease? Instead, season generously with the recipe's spices and invest in an oil sprayer so you can make a little bit of fat go an extra-long way.
Being over 40 doesn't automatically mean that you now have to cut out certain foods to get (or stay) slim—unless you know deep down that a food is truly getting in the way of your goals. "If having a square of chocolate leads to eating an entire bag of chocolate, having a square of chocolate does not work for you," Cederquist says. (Regain control with these 6 tips to stop overeating.) How to Lose Stubborn Belly Fat After 40
Sure, we’re in the golden age of television, but one of the easiest ways to increase your over-40 weight loss is by turning off the TV (as much as it may break your heart to miss the latest GoT). A study published in the American Journal of Clinical Nutrition reveals that people who snacked while watching TV ate 10 percent more per sitting than those who focused on their food. Even more depressing, research published in the Journal of Consumer Research indicates that seeing beauty advertisements can trigger feelings of inadequacy in women, which can often lead to emotional eating.
I’m 45 years old, I’m st my highest weight ever and extremely frustrated. I have fybormyalga and recently had brain surgery so my exercise lever is low. But I’ve been doing the slimfast shakes for the last two months, I cut my calorie intake down but I’ve only lost 6 lbs. Is slimfast even a good way to go or should I try something else. Please help I need to lose 30 lbs.
People tend to focus on the negatives of getting older, which is fair because there are plenty of them! But in my experience, there are a few good things about getting older that help balance out the bad ones. One thing in particular that I’ve enjoyed about getting older is that I have much less patience for nonsense! I feel more confident about what I want, and I care less about the judgments of other people. I also have much less patience for junk cluttering up my house, which is exactly what we’ll be talking about today!
But then I feel sad and exhausted just thinking about this hypothetical life where I'm five pounds lighter but living without blue cheese, strawberry rhubarb pie, and spaghetti. My children are getting older, and I finally have time to talk to my husband, read a book for pleasure, and enjoy a leisurely meal. I don't want to spend this phase of life fighting with every calorie and carb. And for what? To wear the expensive jeans on the top shelf of my closet that I bought after I had the stomach flu and have never been able to fit into again?
Ready to get serious about managing your money and planning for retirement but don’t want to listen to boring financial advisers toss around money and stock jargon you don’t even understand? Good, because Jill Schlesinger is ready to help with informative interviews and financial advice, all crafted with easy-to-understand concepts for those not so financially savvy.
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Gwyneth Paltrow famously turned to a macrobiotic diet in 1999, partly because of her dad’s illness (he died in 2002 from complications from oral cancer), but also because Leonardo DiCaprio planted the seed of “how dirty meat is” in her head years ago. She doesn’t give her kids gluten, she avoids dairy, and pesticides are a no-no. But, see, there's nothing wrong with a weekend treat. For her, it’s cigarettes and booze. It’s all about the ying and the yang, people.
4. You’ve got some unwelcome guests living in your gut – our gut flora (our micro-organism friends) outnumber our own cells by 10 to 1! You could say we are just providing a home for the billions of them. I’m talking bacteria, yeast, fungus, viruses and parasites. We all have good and bad types and generally they all live happily together, but if you have too many of the bad guys through either too many antibiotics, poor diet, infection or other reasons, then they can hugely impact your weight loss efforts.
Now that you know how many calories you eat each day, it's time to increase your metabolic rate. You're not going to rev up your metabolism by eating a huge calorie-filled breakfast or snacking more often. You're also not going to fill up on metabolism-boosting foods or sip on energy drinks or special teas. You're going to keep your diet exactly the same and increase metabolism with movement.
SOURCES: Madelyn Fernstrom, PhD, director of the University of Pittsburgh Medical Center Weight Management Center and associate director of the UPMC Nutrition Center in Pittsburgh. Pamela Peeke, MD, assistant clinical professor of medicine at the University of Maryland School of Medicine in Baltimore. Michi Yukawa, MD, MPH, acting instructor, department of medicine, division of gerontology and geriatric medicine at the University of Washington in Seattle.